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Meta-Analysis
. 2019 Jan;64(1):55-67.
doi: 10.1111/jmwh.12935. Epub 2019 Jan 16.

Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis

Jessica A Ellis, Carolyn M Brown, Brian Barger, Nicole S Carlson
Meta-Analysis

Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis

Jessica A Ellis et al. J Midwifery Womens Health. 2019 Jan.

Abstract

Introduction: Studies have shown that women with obesity have longer labors. The purpose of this systematic review and meta-analysis is to examine existing evidence regarding labor induction in women with obesity, including processes and outcomes. The primary outcome was cesarean birth following labor induction. Secondary outcomes were the timing and dosage of prostaglandins, the success of mechanical cervical ripening methods, and synthetic oxytocin dose and timing.

Methods: Searches were performed in PubMed, MEDLINE, Embase, CINAHL, EBSCO, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Effects, Google Scholar, and ClinicalTrials.gov. Searches were limited to studies published in English after 1990. Ten studies published between 2009 and 2017 were included in this review. All were observational studies comparing processes and outcomes of induction of labor in relation to maternal body mass index. The primary outcome was cesarean birth following labor induction. We assessed heterogeneity using Cochran's Q test and tau-squared and I2 statistics. We also calculated fixed-effect models to estimate pooled relative risks and weighted mean differences.

Results: Ten cohort studies met inclusion criteria; 8 studies had data available for a meta-analysis of the primary outcome. Cesarean birth was more common among women with obesity compared with women of normal weight following labor induction (Mantel-Haenszel fixed-effect odds ratio, 1.82; 95% CI, 1.55-2.12; P < .001). Maternal obesity was associated with a longer time to birth, higher doses of prostaglandins, less frequent success of cervical ripening methods, and higher dose of synthetic oxytocin, as well as a longer time to birth after oxytocin use.

Discussion: Women with obesity are more likely than women with a normal weight to end labor induction with cesarean birth. Additionally, women with obesity require longer labor inductions involving larger, more frequent applications of both cervical ripening methods and synthetic oxytocin.

Keywords: cervical ripening; induction of labor; intrapartum; obesity; oxytocin; prostaglandins; transcervical catheters.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow Chart Describing Literature Extraction Process Abbreviation: OR, odds ratio.
Figure 2.
Figure 2.
Forest Plot of Mantel-Haenszel Fixed-Effect Meta-Analysis Displaying Odds of Cesarean Birth Abbreviations: BMI, body mass index; IOL, induction of labor.
See this image and copyright information in PMC

References

    1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–2291. - PMC - PubMed
    1. Branum AM, Kirmeyer SE, Gregory ECW. Prepregnancy body mass index by maternal characteristics and state: data from the birth certificate, 2014. Natl Vital Stat Rep. 2016;65(6):1–10. http://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_06.pdf. Accessed September 6, 2016. - PubMed
    1. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015;(219):1–8. https://www.cdc.gov/nchs/data/databriefs/db219.pdf. Accessed September 13, 2016. - PubMed
    1. Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief. 2014;(155):1–8. - PubMed
    1. Martin JA, Hamilton BE, Osterman MJK, Curtin SC, Mathews TJ. Births: final data for 2013. Natl Vital Stat Rep. 2015;64(1):1–65. - PubMed

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